JOB VACANCY CAREER OPPORTUNITY JOBS CAREER JOB OPPORTUNITY JOB VACANCIES CAREER OPPORTUNITIES
Requisition #: 27639
Location: Chicago, IL
Pay Opportunity: $60,000.00 - $65,000.00
Bonus Potential: Variable %
Requirements :
ABOUT OUR COMPANY
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
JOB GROUP SUMMARY
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.
EDUCATION
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
- Registered Nurse (RN) is required
FUNCTIONAL WORK EXPERIENCE
- Nurses: Case Management
- Nurses: Discharge Planning
- Nursing: Home Health Care Ambulatory Nursing
- Nursing: Medical-Surgical Care
REQUIRED SKILLS
- Microsoft Word
- Interpersonal Communication
- Record and document information to meet risk, regulatory and accreditation requirements
- Review and evaluate clinical history to identify needed medical services
- Develop patient care management plans
- Manages services such that the member receives care in the most appropriate setting at the most appropriate cost
DESIRED SKILLS
- Apply clinical criteria and guidelines to ensure appropriate administration of benefits and optimum medical outcomes
- Authorize and coordinate required services in accordance with the benefit plan
- Communicate to enhance effectiveness of medical management services (i.e. plan sponsors, claim administrators, physicians, members, family and health care team)
- Evaluate member progress in meeting case management plan goals
- Refer members to alternative healthcare programs (i.e. disease management, case management, vocational rehab, etc.)
- Interacting with Medical Professionals
POSITION SUMMARY
This position will be responsible for Complex Case management of Aetna members with commercial health insurance.
Registered Nurse with current Illinois license and a minimum of 3-5 years recent case management experience or utilization review/discharge planning. CCM is preferred. Home Health Care or Hospice experience a plus. Comprehensive knowledge of the Managed Care environment, ability to verify eligibility, coverage and benefit limitations, conduct initial screening of referred cases for appropriateness for case management, identify needs for intervention and to impact quality of life, assess appropriate care setting and ancillary resources within benefit parameters, collect clinical information from a variety of sources, and collaborate effectively with those involved in case.
Position requires the ability to manage multiple priorities and to work collaboratively within a team environment. Must possess proficient keyboarding skills and computer literacy with the ability to navigate through multiple systems.
ADDITIONAL JOB INFORMATION
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
LOGIN TO APPLY
Following example on how to write a cover letter for Nurse Jobs
Requisition #: 27639
Location: Chicago, IL
Pay Opportunity: $60,000.00 - $65,000.00
Bonus Potential: Variable %
Requirements :
ABOUT OUR COMPANY
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
JOB GROUP SUMMARY
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.
EDUCATION
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
- Registered Nurse (RN) is required
FUNCTIONAL WORK EXPERIENCE
- Nurses: Case Management
- Nurses: Discharge Planning
- Nursing: Home Health Care Ambulatory Nursing
- Nursing: Medical-Surgical Care
REQUIRED SKILLS
- Microsoft Word
- Interpersonal Communication
- Record and document information to meet risk, regulatory and accreditation requirements
- Review and evaluate clinical history to identify needed medical services
- Develop patient care management plans
- Manages services such that the member receives care in the most appropriate setting at the most appropriate cost
DESIRED SKILLS
- Apply clinical criteria and guidelines to ensure appropriate administration of benefits and optimum medical outcomes
- Authorize and coordinate required services in accordance with the benefit plan
- Communicate to enhance effectiveness of medical management services (i.e. plan sponsors, claim administrators, physicians, members, family and health care team)
- Evaluate member progress in meeting case management plan goals
- Refer members to alternative healthcare programs (i.e. disease management, case management, vocational rehab, etc.)
- Interacting with Medical Professionals
POSITION SUMMARY
This position will be responsible for Complex Case management of Aetna members with commercial health insurance.
Registered Nurse with current Illinois license and a minimum of 3-5 years recent case management experience or utilization review/discharge planning. CCM is preferred. Home Health Care or Hospice experience a plus. Comprehensive knowledge of the Managed Care environment, ability to verify eligibility, coverage and benefit limitations, conduct initial screening of referred cases for appropriateness for case management, identify needs for intervention and to impact quality of life, assess appropriate care setting and ancillary resources within benefit parameters, collect clinical information from a variety of sources, and collaborate effectively with those involved in case.
Position requires the ability to manage multiple priorities and to work collaboratively within a team environment. Must possess proficient keyboarding skills and computer literacy with the ability to navigate through multiple systems.
ADDITIONAL JOB INFORMATION
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
LOGIN TO APPLY
Following example on how to write a cover letter for Nurse Jobs
